Peer Reviewed
Feature Article Cardiovascular medicine

TIA: prevent a stroke

Martin Krause
Abstract
Transient ischaemic attacks (TIAs) should be considered as medical emergencies. A patient with a TIA needs rapid assessment and immediate treatment to reduce the risk of stroke and heart attack.
Key Points
  • Patients with transient ischaemic attacks (TIAs) have up to a 25% risk of a stroke, a cardiovascular event or death within the next three months. Most of these events will occur within two days after a TIA.
  • Urgent assessment and intervention after a TIA can reduce the risk of such an event by up to 80%.
  • Assessment of atrial fibrillation, diabetes, hypertension and age allows stroke risk stratification of patients. Patients with a moderate or high risk profile need immediate referral to a TIA clinic or a hospital with the capacity to treat acute stroke.
  • Patients with TIA should be treated as soon as is feasible with a statin and a platelet inhibitor, unless they suffer from atrial fibrillation or have a prosthetic heart valve. In that case, they require an anticoagulant instead of a platelet inhibitor.
  • First-line antiplatelet therapy is aspirin 75 to 150 mg daily. For recurrent ischaemic events, second-line treatment is aspirin plus dipyridamole or clopidogrel alone.
  • All patients should receive a statin after a TIA, regardless of their cholesterol level.
  • Patients with symptomatic moderate- or high-grade internal carotid artery stenosis benefit from immediate endarterectomy. This benefit wears off with time and is much less if endarterectomy is performed later than two weeks after the event.